Premenstrual syndrome (PMS) has a wide variety of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.

Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense.

Still, you don't have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.

Emotional and behavioral symptoms

Tension or anxiety

Depressed mood

Crying spells

Mood swings and irritability or anger

Appetite changes and food cravings

Trouble falling asleep (insomnia)

Social withdrawal

Poor concentration

Physical signs and symptoms

Joint or muscle pain

Headache

Fatigue

Weight gain related to fluid retention

Abdominal bloating

Breast tenderness

Acne flare-ups

Constipation or diarrhea

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days of the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).

When to see a doctor

If you haven't been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor.

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.

Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms.

You're likely to start by seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment, you may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance to prepare.

Write down symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.

Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

Could the symptoms that I'm experiencing indicate a more serious medical condition?

Do you recommend treatment for PMS symptoms? What treatments are available?

Is there a generic alternative to the medicine you're prescribing?

Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

How severe are your symptoms?

On what days during your menstrual cycle are your symptoms at their worst?

Do you have symptom-free days during your menstrual cycle?

Can you anticipate when your symptoms are coming on?

Does anything seem to make your symptoms better or worse?

Do your symptoms interfere with your daily activities?

Have you recently felt down, depressed or hopeless?

Have you or has anyone in your family been diagnosed with a psychiatric disorder?

What treatments have you tried so far? How have they worked?

There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern.

To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends.

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:

Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, Naprosyn, others) can ease cramping and breast discomfort.

Diuretics. When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.

Incorporate exercise into your regular routine

Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.

Vitamin E. This vitamin, taken in 400 international units daily, may ease PMS symptoms by reducing the production of prostaglandins, hormone-like substances that cause cramps and breast tenderness.

Herbal remedies. Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chasteberry, evening primrose oil and St. John's wort. However, few scientific studies have found that any herbs are effective for relief of PMS symptoms.

Herbal remedies also aren't regulated by the Food and Drug Administration, so there's no record of product safety or effectiveness. Talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you're taking. St. John's wort, for example, reduces the effectiveness of birth control pills.

Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.

Reprint Permissions

A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.